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General NPI Number Information
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NPI Number | 1144306226
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Entity Type | Individual
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Provider Name | MARISSA EVERS GORLESKY PT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 30 HEMPSTEAD AVE SUITE 258
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4033
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Country | US
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Telephone | 516-536-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 15 PRINCE LN
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City | WESTBURY
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State | NY
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Zip | 11590-6228
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Country | US
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Telephone | 516-385-4529
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 026110
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License Number State | NY
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